Healing TB in Cambodia and the world

Tuberculosis is curable—whether in the world’s wealthiest countries or in its poorest. But in 1994 when Cambodian Health Committee was founded, the access to TB treatment and care in Cambodia was nearly nonexistent, which had been ravaged by 2 decades of war and extreme poverty.

With a collapsed health system and poor rural access to care in a country of farmers at the time, Cambodia had become a global TB hotspot with one of the highest rates of TB in the world.

And at the time, it was widely believed by international agencies that poor, rural communities were incapable of completing the lengthy 6–8 month TB treatment.

Cambodian Health Committee (CHC) changed that. Starting from the ground up, CHC built a community-based model that overcame every barrier—delivering care through local health workers, bringing treatment to patients' homes, and proving that even the poorest could be cured with the right programatic support.

CHC’s work is grounded in the belief that access to treatment for a curable disease like TB is a human right—and that with the right support, anyone, anywhere, can complete the long and difficult treatment.

Our Origins: From Refugee Camp to Lifesaving Care in Cambodia

CHC’s roots trace back to Site II refugee camp on the Thai-Cambodian border, where survivors of the Khmer Rouge genocide fled in the 1980s. It was there in 1989 that co-founders Sok Thim, Anne Goldfeld, and Brian Heidel, met while working with the American Refugee Committee (ARC) in the camp. Sok Thim coordinated ARC’s groundbreaking TB program -- started by Steve Miles and Bob Maat in 1981-- whose radical approach introduced treatment contracts, food assistance, and patient supporters to TB treatment—defying global experts who believed that refugees with TB couldn’t be treated in a war zone, as they reported. As Steve Miles said in 1981, which is true today, “TB is…about a debilitating, lethal, contagious and curable illness”. The ARC program would treat over 3000 patients in the border camps before the refugees returned to Cambodia in the early 1990s.

In Cambodia, they found a country devastated by decades of war—with no functioning health system or TB care. Even among those citizens who accessed TB treatment, only ~20% completed the required 6-month regimen for cure leaving them still sick and contagious.

In response, the WHO and French Red Cross advised Cambodia to require forced hospitalization for the first 2 months of TB treatment—a policy that was impossible for poor farming families, who couldn’t afford to leave their fields. Even after hospitalization, the long distances and cost of monthly medication pick-up meant patients often dropped out of treatment before completing therapy. Many never sought treatment until it was too late.

In 1994, with seed support from the Blue Oak and the Christopher Reynolds Foundations, the Cambodian Health Committee (CHC) was launched and chose to work in Svay Rieng, one of Cambodia’s poorest provinces with the highest rate of TB infection in the country, to bring TB treatment to the people who needed it the most.

Building on the lessons learned in a life-saving refugee-camp innovation , CHC brought a new model to Cambodia: community-based TB care rooted in dignity, support, and science. CHC’s work became a national health intervention—transforming TB care across Cambodia and influencing programs across the world from Haiti to Ethiopia to Vietnam.

Bringing TB Care to the patient in post-conflict and poverty stricken Cambodia

CHC brought the transformative TB approaches from the border refugee camps (patient supporters, food supplementation, education about TB disease, treatment contracts, and observed consumption of TB medications) to rural Cambodia in 1994, where families at the time lived on less than $220/year and TB prevalence was among the highest in the world estimated to be ~900 individuals with TB/per 100,000 citizens.

Meeting the situation in impoverished rural Cambodia, CHC developed and added new solutions to bring TB care to the community and to patient homes, including:

• Food as Complementary Medicine: Pioneered with the World Food Program, CHC delivered monthly food packages with medicine pickups—now a global best practice.

• Expanding the Role of Patient Supporters: Trained to monitor daily therapy of TB medicine at home and accompany the patients through therapy.

• Establishing Mobile TB Teams: CHC launched mobile health worker teams who visited patients at home, to check in on how the patients were managing to take their medications, while screening other family members for TB infection. If there was an interruption of therapy, the team strategizes with the patient and the supporter about any issues interfering with their TB treatment and how to overcome these.

• Linking Poverty Reduction: Village banks focused on TB patients and families afflicted by TB, offered low interest loans based on the Grameen Bank model. And for example, among 590 TB patients who joined the village bank program between 1995 to 2000, TB treatment adherence and cure were each 100%, and loan payback was 100%. In the same period, a Village Health Fund was created from interest on loan payback that trained Village Health Agents in 96 villages, who performed TB case finding and spread TB health messages.

• Active TB case finding in villages: Mobile CHC teams screened clusters of villages -- going house-to-house -- to find people who may be suffering from TB, rather than waiting for them to seek help at the health center. In this way, TB was be diagnosed and treated earlier, before the infection had caused irreversible impact on patients’ lungs and health.

• TB HOME CARE by CHC mobile teams and patient supporters: This pilot approach involved mobile TB health teams visiting each patient in their home 5 days a week during the initial two-month intensive phase of TB therapy to observe the patient taking their TB medication with the patient supporter supervising the treatment on the weekends. Among 219 TB HOME CARE patients, 100% of patients took their mediation daily and their cure rate was 99%.

• The results of the CHC Program described above were published in the Journal of the American Medical Association in 2004.

These innovations put CHC in a position to transform Cambodia’s TB response in partnership with the National TB Program and led to the development with the Cambodian National TB Program of community TB care or Community Daily Observed Therapy (or c-DOTS), which changed the trajectory of the TB disaster in Cambodia to one of great successes in TB treatment the early 2000s.

Bringing TB care to the most distant village: CHC’s Community TB Care

To reach patients in Cambodia’s most remote areas, CHC launched and scaled-up Community TB Treatment throughout Cambodia with Cambodia’s National TB Program.

CHC’s mobile teams guided both local Health Center staff, patients and supporters, through each phase of treatment, and through community trainings resulting in enhanced detection, education, and cure.

The Community TB Treatment model trained local volunteers—including former TB patients—to serve as treatment supporters, helping neighbors stick to their daily medications by Daily Observed Treatment (DOTS) of the patient taking their TB medication.

Community Treatment or Community DOTS, as it came to be known, was piloted by CHC in partnership with the National TB Program in Svay Rieng and Kompot Provinces beginning with support from JICA (Japanese International Cooperation Agency). In 200 achieving a 95% TB cure rate—a game-changing success in global TB care.

CHC’s pilot worked so well, it was adopted for nationwide scale-up in Cambodia with support from the Global Fund for TB, Malaria, and AIDS, and its scale-up was later credited by the World Health Organization for helping drive down Cambodia’s TB burden and as a global model of success.

CHC Impact: 1994–2025

• From 1994 to 2024, CHC provided community-based TB care to over 110,000 Cambodians in partnership with the Cambodian National TB Program (NTP)—with adherence and cure rates consistently over 90%; and, in most years approaching 95%.

• In 2024, CHC treated 11,361 people with TB across 13 provinces in Cambodia covering a catchment area of nearly 7 million people, achieving a 97% cure rate.

• CHC's efforts have played a critical role in reducing TB incidence nationwide and its partnership with the National TB Program transformed Cambodia from one of the most TB-plagued countries in the world, into a global success story in TB treatment and TB reduction.

• CHC introduced and scaled innovative strategies—including patient supporters, treatment contracts, food supplementation, poverty mitigation, and patient travel support to pick up medicines—strategies which improved case detection, adherence, and cure rates, which have been widely emulated.

• The World Health Organization (WHO) credited CHC’s Community TB model—scaled up with the National TB Program—for the dramatic reduction of TB in Cambodia during the 1990s and 2000s, citing it as a global model of success.

  Through the years, critical funding for this program was provided by The Blue Oak Foundation, Jeanne and Joe Sullivan, the Pittsfield Anti-TB Foundation, Mark Peters, Mimi and Bud Frankel.

Healing the world one life at a time